The Thing We Never Talk About

Today, I'm going to talk about something that nobody talks about. People don't really want to talk about it. It's hard. It's sad. And if anyone has to endure it, they want it to go away quietly because it's too hard to share. I'm talking about miscarriage. And it happened to me.

Within the past two weeks.



These are the things I have learned about miscarriage in my Internet research and conversations with my health care provider.

Why Does it Happen?
The short answer: no reason, or a gazillion reasons. The longer answer (but still not very satisfying), is that sometimes abnormalities within the egg or the sperm (e.g., not enough chromosomes, too many chromosomes, errors in the DNA code that instructs the embryo on how to form, etc.) cause the development to stop early. Sometimes, environmental factors (e.g., toxins in the water, air, or food; exposure to "something" that one should not have contact with in pregnancy) impact the developing embryo. Sometimes, there just is no answer.

How Often Does it Happen?
The short answer: a lot. The longer answer, according to The Hope Exchange (a website providing help after pregnancy loss), is that as many as 25-33% of all known pregnancies end in miscarriage, and up to 40% of all (including pre-positive pregnancy test) pregnancies end in miscarriage. Most of these pregnancies are lost in the first trimester, though some pregnancies are lost after 20 weeks (called stillbirth beginning at 20 weeks).

Am I Normal?
This is a hard question. My personal philosophy is that "normal" is a setting on the washing machine. But in the grander scheme of things, miscarriage is an unfortunately common experience. Almost 20% of the adult population has experienced the loss of a child (either in utero, or at some time in their lives). About 80% of miscarriages are one-time occurrences. Most people who experience a miscarriage only experience it once. Health care providers only conduct testing after three consecutive miscarriages (unless there is some indication in your medical history to check for problems before that).

What Should I Do if My Pregnancy isn't Viable?
There are three options on how to manage a pending miscarriage from the healthcare perspective.
1. Watch and wait. This is the fancy medical term for "natural" miscarriage. If the gestation stops progressing early (no more than about 7-8 weeks), even if not detected until later in expected pregnancy duration, the body will begin to expel the tissue on its own. 90% of miscarriages using this procedure will effectively end in complete miscarriage (e.g., all pregnancy-related tissue is expelled).
2. Medicine. Taking misoprostol (brand name: Cytotek) will expedite the miscarriage process. The body would still expel the tissue, but the process would occur faster (over a matter of hours, rather than days). Expect to have diarrhea, substantially more cramping than a natural miscarriage, and possibly more bleeding. If the watch and wait method has ended in incomplete miscarriage (e.g., some tissue from the pregnancy remains in the body), this medicine is used to "help" the process along.
3. D & C. Dilation and Curettage (or, more commonly, Dilation and Suction) is a very common treatment of miscarriage that works 100% of the time, no matter what type of miscarriage you are having. This is a medical intervention that involves sedation with anesthesia, local anesthetizing of the cervix, artificial dilation of the cervix, and suction of all tissue from the uterus.

Wait, there are TYPES of Miscarriage?
Yes, there are a few types. Embryonic Demise or Blighted Ovum is when the pregnancy has started but stops progressing for some reason. This usually happens very early in pregnancy. Incompetent Cervix is when a pregnancy is affected later (usually in second or third trimester) because the cervix is weak and begins to open due to the pressure from a growing baby. These happen in 1 of 100 pregnancies, and usually only if the cervix has been affected in some way by previous surgery, a previous traumatic birth (excessive tearing of the cervix), malformed uterus, or other defect. Anembryonic or Empty Sac pregnancy is when the pregnancy begins and a gestational sac is formed, but no embryo develops at all. These types of pregnancies usually require either the medicine or D &C approach to managing the miscarriage because the body will only naturally expel the tissue about 2/3 of the time. It may also be helpful to know that the medical term for miscarriage is Spontaneous Abortion. Abortion when it relates to pregnancy means "stopping the progression of pregnancy," and spontaneous means "it just sort of happened."

How do I Deal with Miscarriage?
This is a very personal thing. Miscarriage results in grief for many families. If it is your friend who is experiencing a miscarriage, imagine that she is experiencing the death of her child. Because she is. The pain and grief is unimaginable. And because of that, she may be acting angry, sad, indifferent, or any combination. Grief is funny that way. Most often, people feel angry and direct it at anything and anyone who happens to be nearby. Do not take this personally. If she's acting like she's in another world somewhere (this is called dissociation), she probably is. The real world keeps going on as if nothing happened. Her internal world is a mess of emotions and pain, and she can't really function there either. So she might "go away" for a while to help herself function in the real world and not necessarily address the internal mess. That's okay for a little while, but ultimately, we all have to face that grief. Otherwise, we might forget our way back to those emotions, and they'll keep poking their way into our lives in situations that are totally inappropriate. Like making us lash out at our spouses or children or friends.

Dealing with miscarriage is a challenge because people don't talk about it. Nobody knows what to say. Nobody has the right words, so they say nothing. Or they change the subject. Or they pretend nothing's wrong because they think that might be helpful. In actuality, it sends the message that our pain is insignificant, or that we can somehow be able to move on faster than we would if grieving a person we'd actually met. But what so many fail to realize, is that parents have made plans, have hopes and dreams, and maybe even imagine they know the little life they've created. They love the child they haven't met yet. And when a miscarriage happens, all of those things become meaningless or lost. They become part of the grief. And in some way, there's a darkening of hope for the future because their new little future is no more. They have to find out what their life is again. Now that it's missing a very special someone they've dreamed about, maybe before that someone was even conceived.

Sometimes, people rely on their faith to help them through this difficult time. Sometimes, people have crises of faith and blame their Deity(ies) for what has happened. Sometimes, people rely on friends who have had this experience. Sometimes, people become angry at friends because nobody has experienced the pain they feel right now. Sometimes, people quietly endure the grieving process. Sometimes, people choose to seek help from a therapist. I have chosen the latter because, again due to my personal philosophy, I am a therapist and cannot sell something I wouldn't choose to buy for myself. Therapy allows me to be angry, sad, afraid, confused, and whatever else I go through, without judgment. And therapy allows me to find the answers I seek within myself. Because they are there, even if I can't see them right now.

The Yacht Club

Evidently, my children are boaters. One small problem.... we do not, nor can we afford to, own a boat. The pictured boat belongs to my brother-in-law and his father. While a modest income can certainly afford a boat (we grew up with one), the additional costs of maintaining, storing, and using one can be far outside the limits. In my mind, I would imagine the only people who have boats and use them more than once or twice a year are either (a) fishermen or (b) people who use the names of seasons as verbs (e.g., "We shall summer in New England this year").

Siblings on Uncle's boat 

Meanwhile, the babies are no babies. My, how they've grown! My girl is now a five-year-old who has completed a year of pre-K at a lovely school in our area. She moves on to kindergarten this fall. Her aunt (wife of the boat-owner, and my sister) is pregnant. So, now my darling daughter pretends to be pregnant as well. She has no idea how much the prospect of her becoming pregnant (like EVER) terrifies me. Of course, someday this fear will vanish, I'm sure. There will come a time when grandchildren will seem like fun (rather than the death knell of my youth).

Five years old - the Skipper

We experienced our first (ever) fracture. During soccer, she had an avulsion fracture of her right fibula after tripping over a soccer ball. Never mind that it occurred because I might have allowed her to wear inappropriate shoes. She's taking it well, and is allowed to walk around with an air-cast. However, I should clarify that this child does not walk. She hops. She skips. She jumps, dips, dives, and does pretty much everything her doctor said not to do. And why not? She's five.

Two years old - the First Mate

My boy is two, and not the terrible kind. I'm convinced two is "terrific" and three is the "terrible" one. We'll see, come this time next year. Potty-training will be on the agenda for this year (hopefully this summer). He already senses the bodily urge and knows how to use the toilet, but his interest waxes and wanes (or, more appropriate to the theme, ebbs and flows like the tides).

He speaks rather well, but we've learned that his adenoids are enlarged and may be impacting his speech and breathing. While he gets sufficient oxygen, his sleep is likely impacted from snoring, and his speech is affected by the poor airflow during specific lip and mouth movements. We have a follow-up otolaryngology (ENT) consultation to determine if he will need surgery. While I try to wrap my mind around surgery on my baby boy, I have heard from other moms whose children managed to survive adenoidectomies.

Finally, we consider for a moment the possibility of expanding our family. What might that do to our great dynamic? How will the first two react to a third? They each have selected a same-sex sibling, as well as a name - the daughter wishes for a sister named Daisy Sunrose, and the son wishes for a brother with the same name as he has (because it is SO EPIC). And then, there are the financial considerations of how to manage upgrading a car (a must, to fit in a third child seat), where we'd all sleep, and how to pay for child care (which already costs more than our mortgage). So much for the yacht club.

Intervention

Wow. It's been nearly one year to the DAY since the last post. Two little kids with their two parents in graduate school is no joke.

This (year's) post title, "Intervention," seems appropriate on multiple levels. When life gets so busy that you don't have time to stop and.... I dunno...breathe the oxygen, it's time for someone to knock you upside the head and tell you to slow down for a second. While we spend the majority of our time running around like the White Rabbit from Alice in Wonderland, we do actually get a few moments to pretend we're a "normal" family. Of course, I use the word normal loosely. I firmly believe it's a setting on your washing machine and nothing more.

Today was one of those days we got to be somewhat normal. When I titled the post "Intervention," the intent was a little different than the aforementioned. My children, ages five and two, have now gotten to the wonderful age where arguments occur. Maybe even brawls. Today's example was when the 2-year-old boy asked (in the sweetest, most polite manner I've ever heard) his big sister if he could play with one of her toys, she SCREAMED in wild protest, "NO!!! NO!!! NO!!!" To which, the boy cried huge, devastating crocodile tears.

No one was harmed in this exchange. Physically, anyway. I often wonder as a parent when I should intervene. I wanted to do it today, but I did not, and here's why:

I have a rule I use with the 5-year-old on tattling. She is REALLY bad about doing it ALL the time. She doesn't get the concept that, "Nobody likes a snitch." Instead, I've resorted to providing clear-cut examples of when it is appropriate to "snitch" and when it is not. Bottom line: it's okay to tattle when someone is in danger or if someone's property is in danger. I'd like to take credit, but my sister let me borrow a book called Help Me Be Good: Tattling (one in a great series, actually) that helped a lot.

Anyway, I figured the same rules should apply to me. If nobody is in danger, and nobody's stuff is in danger, I should really let them work it out. They need to problem-solve on their own, and they'll never get practice if I keep breaking it up all the time. While I certainly wouldn't just let them go wild, I think they are not in the right mindset to accept a "teaching moment" (read: a lecture on the proper way to negotiate) when they're already in the throes of a knock-down, drag-out tumble over a toy.

The husband and I try our best to demonstrate clear examples of how to problem-solve as a team and negotiate the terms of a compromise. Additionally, there are plenty of opportunities to observe other kids or even use television (I know, I know... the evil box that sits in the living room babysitting other people's kids) to show where the actors (or cartoons) could have done something different.

Besides, I'm tired of screaming, "Knock it off!" from the top of the stairs.

Walking and talking

Time, please pause. If you don't slow down I will miss everything!!!

My son is 13 months, 3 weeks old. He is walking. Everywhere. And he says about a dozen words now. One of them (finally) is "Mama." Here's a short list:

• Mama
• Dada (and sometimes "Daddy")
• Eat
• Cracker
• Car
• Red
• Why
• No
• Hot
• Good
• Go
• Ooooh! (when something is exciting to him)

My dear daughter has been giving us new challenges as the boy increases his abilities. She has now begun to play even more rough with him. She hits, pushes, knocks him down. She takes toys away. She pretends to be a baby because we have provided the excuse for his own impulsive (but perfectly normal) behaviors.

Sometimes, she does the most amazing things without being asked. She has made her bed, cleaned her room, gotten fully dressed, gotten her own breakfast, and other tasks. At four years old, I consider this quite impressive. Other times, however, she has displayed emotional dysregulation over small things, intense frustration at not being able to put on her shoes (at task at which she has been proficient for at least 2 years), and total breakdowns in rationality. Although all of these things are (somewhat) age appropriate, I wonder how much of it can be attributed to this little guy coming in and taking away all her attention.

We need to enroll her in acting classes.

Overall, however, we are blessed with beautiful, (mostly) well-behaved, and VERY happy children. I cannot believe how quickly time just flies away. Time, please, please, slow down.

Where, oh where, did a year just go?

ZOOM.

On the day after we celebrated (as in, with an actual PARTY celebrated) our son's first birthday, I realize that there are so many things that tend to happen almost at light speed, and there is just no way to capture them all. The boy actually turned one nearly 2 weeks ago, but I didn't have a moment to spare for him (or guests) until this weekend.

Things I've learned in the past six months:
(1) Parenthood does not get easier just because I've done it before. Each kid apparently presents new challenges. (more on this later)
(2) Both parents being enrolled in Ph.D. programs while also trying to raise two kids is completely insane.
(3) If we don't have time for something, it's okay to say no.... even if it's a major holiday and/or people's feelings will be hurt.
(4) No matter how busy we get doing whatever it is we do, our little family comes before pretty much everything else.

Words.
J now says a handful of words. The first one spoken was "Dada" at about 6 months. He now fully associates "Dada" with his father, which is cool. He also says "NO!" He's become quite proficient at the use of "Uh-oh," even though he sometimes says it as a preemptive measure (i.e., BEFORE throwing his cup on the floor from the kitchen table). He says "Hot," when near the stove or if he hears anything remotely sounding like it (although it comes out more as "HAH-tah"). But he will not say, "Mama." Like, at all. He said it on Christmas Day, and I thought how wonderful a gift he'd just given me. But apparently, it's not the kind that keeps on giving. Everyone keeps telling me he's pulling my leg, though one bit of advice sticks out...."Don't worry; once he starts saying it, you'll regret wishing he would because he'll never let you rest!" Hmmm, valid point.

I still want to hear him say, "Mama," and know it's me. Just sayin...

Boy versus Girl.
Okay, it could be sex differences, or it could be just different kid things. However, I've noticed that we've had to go to great lengths in managing our lives with the boy in it. We have had to childproof everything. Okay, we sort of did it with E because we were first-timers, but she never got into so much trouble. J, on the other hand, has tried to leap over the banister down the stairwell, jump off our bed, fly off the diaper changing table, stick things in electrical outlets (regardless of if they're covered), get into cabinets, pull things out of cabinets, and pretty much destroy anything delicate that isn't placed on a very high shelf or out of sight.

We now live with a cage around our television. The remotes must be hidden from him or batteries removed so that we don't find the TV displaying something we've never seen before. We have to watch out for our phones so he doesn't call someone in China. We have a gate blocking off the top of our stairs. And all this for a boy who isn't quite yet walking!!! He took a few steps yesterday and the day before, but he's not quite ready. And we're not exactly disappointed by that.

We call him the B.B.O.E., which stands for the "Busiest Boy on Earth," and he is. He is always looking around for mischief, always curious, always being nosy, always getting into something. On the positive side, our little investigator has an inquisitive mind and is likely quite intelligent. We just have to keep from tearing our hair out while we wait for this genius to emerge.

A time for milestones

My six-month, 24-day old son has now learned to clap his hands. He's about 2 months ahead of where his sister was on this development. He has also (for about 2 weeks now) been rolling over from back to front. Unfortunately, he hasn't quite learned to roll the other way consistently, so he frequently rolls over in the middle of the night and gets frustrated because he cannot roll back. Persistent grunting turns into crying, and that means I get to leave my warm comfy bed (sometimes SEVERAL TIMES) during the night. Part of that could also be teething-related; something he's also doing a couple months in advance of his sister, who got her first tooth at 8 months.

We've also begun trying solids. Apart from the oatmeal and rice cereal the pediatrician recommended for iron supplementation, he's now tasted squash (and LOVED it), carrots (which stain worse than blood - I recommend getting Shout! or another stain remover), peas, and green beans (which he equally detests). He has also had applesauce (and I'm not sure if he really likes it because he makes the same "yuck" face he makes with green veggies). Still, he's a super kid and continues to eat it despite the "yuck" face. Unfortunately, with solids comes the end of those cute breast-fed baby poops. They aren't horrifying yet, but they will be getting worse and worse as the consistency of the foods he tries increases.

My three-year, 8-month-old daughter can write nearly all the letters of the alphabet on her Magna-doodle. She talks herself through the process, which is not only adorable, but also lets us know what type of learner she is. Saying things aloud while doing them means she is an auditory learner. Just like her daddy! "So the P is a line down, and a loop on the side!"

Naps continue to be a struggle with her, but she managed to take one 3 days in a row at our daycare provider's home. The provider did a mock-phone call to us as a fear inducer. She really wants to please us, so she went right to sleep. I think this only had to be done once, with reminders the next two days ("Remember, I will call Mommy and Daddy to tell them you aren't sleeping..."). Of course, she knows that if she DOES sleep, she gets to watch one of her favorite cartoons when she gets home, before dinner. As parents, we actually HATE it when we can't reward her for making good choices. The cartoon thing is also a way to keep her occupied while we make dinner in the evening. Of course, our little girl does love to help. And helping is perfectly okay for a 3 1/2-year-old to handle.

She can set the table (one dish at a time), place out the silverware, take empty cups over, etc. After dinner, she helps with clean-up. Now that she is no longer terrified of our Dust-Buster, we let her use it to get the crumbs off our hardwood floor under the table each night. Usually it's her mess anyway. She also helps clear the dishes (she's still too short to place items in the sink, and letting her throw them in has already ended in 2 broken dishes) - she brings them to one of us, who is already sink-side.

Starting them early on routine house maintenance and the concepts of cleaning up what we mess up will help keep us from having an infuriating teen-ager who does nothing. At least, that's the hope!

Rice is nice.

Today, little J (who is a few days shy of his 5-month-birthday) had a few bites of rice cereal mixed with breast milk.  His face was just precious.  He very happily opened his mouth when the spoon came near it, but the first bite was quite obviously not what he expected.  There was some blowback.  The next few bites went a little better, and he became a little chow-hound.  It got to the point where I apparently was not fast enough with the spooning, so he tried to help expedite by grabbing the spoon.  This served only to dump its contents into my lap.  He quickly got angry.  We opted to "boob him up" for the rest of this feeding.

He has been physiologically ready for solids for about a month now, but since he was gaining weight at a very decent pace (95th percentile) I felt it unnecessary to introduce rice cereal.  In addition, J may (or may not) be our last baby, so there is a very unique desire to keep him a baby for longer.  Since he sat unsupported at 20 weeks (we have to put him there, but he can stay up pretty well), it was time.  Unfortunately, he cannot quite sit in a high chair or anything so solids will definitely wait until at least the recommended six months.